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General NPI Number Information
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NPI Number | 1326311705
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL IMPLANTS
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 411 STRANDER BLVD SUITE 205
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City | TUKWILA
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State | WA
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Zip | 98188-2935
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Country | US
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Telephone | 800-469-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 411 STRANDER BLVD SUITE 205
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City | TUKWILA
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State | WA
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Zip | 98188-2935
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/ PERIODONTIST
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Name | MR. DARRIN RAPOPORT
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Credential | BDS, MSD
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Telephone | 206-575-1086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DE00008508
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License Number State | WA
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